NPIMap

Organization Active NPI

Kenneth L Pettit DO LLC

  • Family Medicine Physician
  • Chandler, AZ
National Provider Identifier
1750585279
Registry record updated Jan 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
AZ3344 Issued in AZ
Legal business name
KENNETH L PETTIT DO LLC
Doing business as
Comprehensive Family Care
Practice address
40 S Kyrene Rd
Suite 1
Chandler, AZ 85226-4675
Phone
(480) 706-0174
Fax
(480) 706-0117
NPI assigned
Jun 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vanessa Pettit
Title
Owner/Manager
Phone
(480) 706-0174

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X AZ3344 AZ Primary

Addresses

Primary practice location

40 S Kyrene Rd
Suite 1
Chandler, AZ 85226-4675

Mailing address

40 S Kyrene Rd
Suite 1
Chandler, AZ 85226-4675
Phone (480) 706-0174

Other names 1

  • Comprehensive Family Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040526001496 AZ Part B Supplier - Clinic/Group Practice 2163403072 Receives reassigned benefits from 1 practitioner
Practice locations: Chandler, AZ

National Provider Directory

National Provider Directory

Locations

40 S Kyrene Rd
Ste 1
Chandler, AZ 85226
Phone (480) 706-0174

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1750585279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 S KYRENE RD",
            "address_2": "SUITE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852264675",
            "telephone_number": "480-706-0174",
            "fax_number": "480-706-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 S KYRENE RD",
            "address_2": "SUITE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852264675",
            "telephone_number": "480-706-0174",
            "fax_number": "480-706-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH L PETTIT DO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "480-706-0174"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "AZ3344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comprehensive Family Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Comprehensive Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.